"In the Interest of Scholarly Discourse"
Dear Editor:
I read Dr. James Lehman’s excellent article, “Adverse Reaction to Chiropractic Manipulation: Consider This Case,” in the March 2025 issue of Dynamic Chiropractic. I am hesitant to disagree with my colleague Dr. Lehman on anything. However, in the interest of scholarly discourse, I would dispute the answer to the first question of the quiz at the end of the article.
The question was: “Signs of a cervical artery dissection (CAD) include posterior neck pain and stiffness, blurred vision, weakness or numbness, loss of balance, and dizziness.” The answer was: True.
I propose that posterior neck pain and stiffness are signs of a CAD due to the arterial tear; but blurred vision, weakness or numbness, loss of balance, and dizziness are ischemic symptoms of stroke that may result from the dissection, not the dissection itself. Lumping them together falsely attributes stroke-specific ischemic symptoms to the dissection alone, which can obscure cases in which manipulation of a pre-existing dissection causes a stroke.1
Any provider performing cervical spine manipulation (not just DCs) should be aware of the symptoms of a potential CAD (posterior neck pain and stiffness) and the symptoms of a potential stroke (blurred vision, weakness or numbness, loss of balance, dizziness), and perform a thorough history-taking and examination to exclude CAD and stroke prior to neck manipulation.2
Sources in the literature often list ischemic symptoms as symptoms of dissection.2 This has been a common misconception in the literature for many years. Clear distinctions between posterior neck pain and stiffness caused by dissection and ischemic symptoms caused by a dissection-related stroke are essential in the discussion of this topic.
I agree with Dr. Lehman that there is nothing in the literature that describes a toxin release post-cervical spine manipulation. I recently published a study in the journal Medical Hypotheses on this topic: “Stroke vs. Toxin Release After Chiropractic Spinal Manipulation: A Plausible Hypothesis.”3
Steven Brown, DC, DIAMA
Gilbert, Ariz.
References
- Brown SP. Plausible mechanisms of causation of immediate stroke by cervical spine manipulation: a narrative review. Cureus, 2024;16(3):e56565.
- Chaibi A, Russell MB. A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: a comprehensive review. Ann Med, 2019;51(2):118-127.
- Brown S. Stroke vs. toxin release after chiropractic spinal manipulation: a plausible hypothesis. Med Hypotheses, 2025;198.
